Young pediatric surgeons without endoscopic surgical skill qualification safely perform advanced endoscopic surgery under the supervision of expert qualified surgeons

Infographic · Jun 2025 · 1 min read

In brief

Retrospective study of 246 pediatric MIS cases demonstrates that non-credentialed surgeons achieve comparable outcomes to qualified surgeons when supervised by experts. Analysis of choledochal cyst, biliary atresia, and lobectomy procedures shows no significant differences in complications or blood loss, supporting supervised training models in pediatric endoscopic surgery.

Young pediatric surgeons without ESSQ qualification achieved equivalent perioperative outcomes to qualified surgeons when supervised by experts.
No significant differences in operative time, blood loss, or complications for choledochal cyst and lobectomy cases between ESSQ and non-ESSQ groups.
Biliary atresia cases took longer with non-ESSQ surgeons (377 vs 310 min), but complication rates and jaundice outcomes remained comparable.
Supervised training model allows safe skill development in advanced MIS without compromising patient safety across multiple complex procedures.
ESSQ supervision framework enables effective knowledge transfer while maintaining quality standards in pediatric minimally invasive surgery.

Written by the GCMD Library team from the infographic.

Kazuki Ota, Takahisa Tainaka, Akinari Hinoki, Chiyoe Shirota, Satoshi Makita, Akihiro Yasui, Yoichi Nakagawa, Daiki Kato, Takuya Maeda, Hiroki Ishii & Hiroo Uchida

Background: Young pediatric surgeons should receive adequate training in various minimally invasive surgeries (MIS). However, it is essential to maintain patient safety and outcomes during the learning process. In Japan, the endoscopic surgical skill qualification (ESSQ) system in pediatric surgery was initiated by the Japan Society for Endoscopic Surgery (JSES) in 2009 to objectively evaluate the skill of endoscopic surgeons. This study compared perioperative outcomes between pediatric surgeons with ESSQ qualifications and those without (non-ESSQ).

Methods: We retrospectively reviewed the medical records of children with choledochal cyst (CC), lobectomy, and biliary atresia (BA) who underwent MIS at our hospital from 2013 to 2023. We assessed the performance of nonqualified surgeons assisted by supervisors with ESSQ qualifications.

Results: This study included the records of 101 surgical cases with CC (operated by ESSQ: 36, non-ESSQ: 65), 78 patients with BA (operated by ESSQ: 35, non-ESSQ: 43), and 67 patients with lobectomy (operated by ESSQ: 31, non-ESSQ: 36). For the CC and lobectomy groups, there were no significant differences in operating time, blood loss, and postoperative complications (PO) between the ESSQ and non-ESSQ groups. In BA, the operative times for the ESSQ and non-ESSQ groups were 310 and 377 min, respectively (p = 0.001). Furthermore, no significant differences were observed in blood loss, PO, jaundice-clearance ratio, and jaundice-free survival rate with the native liver between the two groups.

Conclusion: The results indicate that young pediatric surgeons can safely perform MIS while practicing under the supervision of experienced ESSQ-qualified surgeons.